A ten-year analysis of adults presenting with previously untreated adolescent idiopathic scoliosis (AIS) has found that patients with unoperated AIS reported low assessment scores for pain, self-image and function in adulthood and scored similar to age-match controls without AIS. Patients electing for surgery after presentation had worse pre-operative Oswestry Disability Index (ODI) and SRS-22r scores compared to the non-surgical patients.

These were among the conclusions of Jace Erwin and colleagues from the University of Kansas Medical Center (Kansas City, USA), who carried out the study. The research was presented at the International Spinal Deformity Symposium (ISDS 2019: 5­­–7 December, New York, USA) by Brandon Carlson. The study was selected as the Best Paper at the meeting.

As part of their retrospective, cross-sectional analysis, Erwin and colleagues evaluated ODI and SRS-22r questionnaire responses from adult patients with no previous surgery, who were seen in a tertiary spinal deformity clinic from 2008–2018. These assessments were compared to age-adjusted normative values in order to describe differences between patients treated non operatively and those treated surgically. The study team hypothesised that adults with AIS and no history of surgery in adolescence would have health-related quality-of-life (HRQOL) metrics correlating with age, Cobb angle, and progression of surgery, and that ODI and SRS-22r scores would be similar to age–gender matched controls based on previously published reports.

Patients included in the study were those with a diagnosis for AIS, aged 20 years or above, with a Cobb angle >10 degrees and a spinal apex >L2. Patients with non-AIS scoliosis were excluded, as were those who had previously undergone surgery. A total of 255 patients (84% female) met the inclusion criteria; mean age was 41 years. Of these patients, 220 (86%) reported ODI scores and 204 (80%) reported SRS-22r scores.

The study team found that ODI had a positive linear correlation with each age group, as well as thoracic Cobb size, thoracolumbar Cobb size and body mass index BMI. The study team also saw that ODI differed between age groups—patients in the 20–39 year group (n=109) reporting an average ODI score of 18.03; while for those in the 40–59 year age group (n=64), the average reported score was 25.27, and average ODI score increased to 32.36 in the ≥60 years age group (n=47).

The results presented by Carlson at the ISDS meeting showed that ODI scores in the age groups <65 years were higher in the study cohort than those compared to age-normative scores, but in age groups >65 years there was no significant difference. Carlson explained that the average ODI was higher in the surgical group (48.5 vs. 23.3), and the study team found that there was a worse reported pain and self-image SRS-22r score for all of the groups, as well as worse function for females >40 years. Carlson added that there were worse SRS-22r scores in function (2.65 vs. 4), pain (3.17 vs. 2.12) and self image (2.37 vs. 3.07), although a better score in mental health.

In his presentation at ISDS, Carlson pointed out that the data add to the knowledge and natural history studies that have been performed on AIS patients. He said: “Nonoperative treatment has been followed in a 60-year follow-up and has shown, similar to our findings, that ODI remained low in patients that did not have surgery.”

Other conclusions reported by the study team were that ODI scores positively correlate with age, BMI, and coronal Cobb angle. They also noted that in patients with surgical-sized scoliosis curves (Thoracic ≥50 degrees; Thoracolumbar ≥40 degrees), few patients (10%) went on to surgery. Surgical patients were found to have higher ODI and SRS-22r scores on average, with no difference in age or curve size compared to the nonsurgical cohort. The study team concluded: “Our results demonstrate that the decision for surgery in adults with untreated AIS, while rare, correlates with worsening ODI and SRS-22r scores, and these findings may assist surgeons when counselling patients presenting with AIS either in adolescence or adulthood.”